ICD-10 F32 Depression Codes: Therapist Guide

Depression is one of the most common conditions therapists treat, yet coding it correctly remains a persistent challenge. The F32 category covers major depressive disorder, single episode, and selecting the right code requires careful clinical assessment. This comprehensive guide walks you through every F32 code, severity distinctions, documentation requirements, and common pitfalls that trigger audits.

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US Adults with Depression

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F32.x

Single Episode Codes

Understanding the F32 Category

The F32 category in ICD-10-CM specifically describes major depressive disorder (MDD) when a client is experiencing their first or only depressive episode. This distinction matters because recurrent depression uses an entirely different code set (F33). Before assigning any F32 code, you must confirm this is genuinely a single episode, not a recurrence of previous depression.

The key question to ask: Has this client ever experienced a major depressive episode before? If yes, even if it was years ago and fully resolved, you should be using F33 codes instead. If this is truly their first episode, F32 is appropriate.

Clinical Tip

Always document your rationale for single vs. recurrent classification. A simple note like "Client denies any previous depressive episodes" or "Per review of records, no prior MDD diagnosis" protects your coding decision during audits.

Complete F32 Code Breakdown

Each F32 code represents a specific severity level and clinical presentation. Understanding these distinctions helps you select the most accurate code for each client.

F32.0 - Mild Depression

Client meets criteria for MDD but symptoms cause only minor functional impairment. They can typically maintain work, relationships, and daily activities with some difficulty.

•5+ symptoms present
•Symptoms distressing but manageable
•Minimal occupational/social impairment

F32.1 - Moderate Depression

Symptoms cause noticeable functional impairment. Client struggles with work performance, relationships, or daily responsibilities but remains partially functional.

•Multiple symptoms beyond minimum
•Clear functional difficulties
•Between mild and severe presentation

F32.2 - Severe Without Psychosis

Significant symptom severity causing major functional impairment. Client may be unable to work, maintain relationships, or complete basic self-care. No psychotic features present.

•Most or all symptoms present
•Marked functional impairment
•No hallucinations or delusions

F32.3 - Severe With Psychosis

Severe depression accompanied by psychotic features such as hallucinations or delusions. These are typically mood-congruent, like hearing voices saying they are worthless.

•Meets severe criteria
•Hallucinations and/or delusions present
•Usually mood-congruent themes

Additional F32 Codes

Beyond the severity-based codes, F32 includes several other important options that address specific clinical situations.

F32.4 - In Partial Remission

Use when a client previously met full criteria for a single depressive episode but now has fewer symptoms or reduced severity. Some symptoms persist, but they no longer meet the full diagnostic threshold.

Documentation requirement: Note which symptoms have resolved and which remain.

F32.5 - In Full Remission

The depressive episode has fully resolved. No significant symptoms remain. Use this when continuing to monitor a client who has recovered but may still benefit from maintenance therapy.

Documentation requirement: Confirm absence of symptoms and reason for continued treatment if applicable.

F32.89 - Other Specified Depressive Episode

Use when a depressive presentation does not fully meet criteria for any specific F32 code but you want to specify the nature of the depression. Requires documentation of why standard codes do not apply.

F32.9 - Unspecified Depressive Episode

A depression diagnosis when severity cannot be determined or insufficient information exists for a more specific code. Use sparingly, as this is an audit red flag when overused.

Warning: Excessive use of F32.9 suggests inadequate clinical assessment and may trigger chart reviews.

F32 vs. F33: Knowing the Difference

One of the most common coding errors is using F32 when F33 should be used, or vice versa. Understanding this distinction is critical for accurate coding.

F32 - Single Episode

First lifetime depressive episode
No prior MDD diagnosis in history
Client denies previous episodes
Records show no prior treatment for depression

F33 - Recurrent

Two or more lifetime episodes
Previous MDD diagnosis documented
Client reports prior depressive episodes
Prior antidepressant treatment for MDD

Assessing Depression Severity

Choosing between mild, moderate, and severe requires systematic assessment. Here is a checklist approach to guide your clinical decision-making.

Severity Assessment Checklist

Symptom Count (DSM-5 Criteria)

Depressed mood most of the day, nearly every day
Markedly diminished interest or pleasure
Significant weight loss/gain or appetite change
Insomnia or hypersomnia nearly every day
Psychomotor agitation or retardation
Fatigue or loss of energy
Feelings of worthlessness or excessive guilt
Diminished ability to think or concentrate
Recurrent thoughts of death or suicidal ideation

Functional Impairment Assessment

Able to maintain employment/school attendance?
Completing basic self-care (hygiene, eating)?
Maintaining important relationships?
Managing household responsibilities?

Severity Determination Guide

Mild (F32.0): 5 symptoms, minor functional impact, client managing most responsibilities.
Moderate (F32.1): 6-7 symptoms or significant functional difficulties despite fewer symptoms.
Severe (F32.2/F32.3): Most symptoms present, major functional impairment, may be unable to work or care for self.

Documentation Requirements

Proper documentation protects your coding decisions and supports medical necessity. Every F32 diagnosis should include specific elements in your clinical notes.

Required Documentation Elements

Episode history: Document whether this is first episode or recurrent, including how this was determined

Symptom enumeration: List specific symptoms present, not just "meets criteria"

Severity rationale: Explain why mild, moderate, or severe was selected

Functional assessment: Describe impact on work, relationships, and daily activities

Psychotic features: If using F32.3, document specific hallucinations or delusions

Risk assessment: Suicidal ideation screening and safety planning if indicated

Common Audit Triggers to Avoid

Insurance auditors and compliance reviewers look for specific patterns that suggest coding problems. Here are the most common issues with F32 codes and how to avoid them.

Audit Red Flags

X Overuse of F32.9 (unspecified)
X Same severity code for 6+ months without reassessment
X F32 used when history shows prior episodes
X Severe code without documented functional impairment
X F32.3 without documented psychotic symptoms
X No symptom documentation supporting the code

Audit-Proof Practices

✓ Use specific codes whenever possible
✓ Reassess and update codes as symptoms change
✓ Document single vs. recurrent determination
✓ Include functional impact in every note
✓ Use standardized measures (PHQ-9, BDI)
✓ Document symptom changes over time

When to Reassess and Update Codes

Depression severity changes over the course of treatment. Your coding should reflect these changes to maintain accuracy and demonstrate treatment progress.

Reassessment Schedule

Consider code changes at these intervals:

Every 4-6 sessions: Review symptom severity and functional status
After significant life events: Job loss, relationship changes, losses
When treatment changes: New medication, therapy modality shift
When client reports improvement: Validate with clinical assessment
Quarterly at minimum: Even if no obvious changes, document stability

A client who initially presents with severe depression (F32.2) may improve to moderate (F32.1) after several weeks of treatment. Updating the code reflects treatment progress and supports continued medical necessity. Similarly, if a client worsens, updating to a more severe code documents the change in clinical status.

Frequently Asked Questions

Can I use F32 if the client had depression years ago but fully recovered?

No. If a client has ever had a previous major depressive episode, even if it was decades ago and fully resolved, the current episode is considered recurrent. You should use F33 codes instead. The only exception would be if the previous episode was a different type of depression (like adjustment disorder with depressed mood) that did not meet MDD criteria.

What is the difference between F32.4 (partial remission) and F32.0 (mild)?

F32.4 indicates a previously more severe episode that has improved but not fully resolved. The client no longer meets full criteria for MDD but still has some symptoms. F32.0 indicates a current episode that meets full MDD criteria but presents with mild severity and minimal functional impairment. The distinction is trajectory: F32.4 is getting better, F32.0 is a current full episode at mild level.

How do I code depression with anxiety?

If a client has comorbid depression and anxiety, code each separately. Use the appropriate F32 code for the depression and add the relevant anxiety code (such as F41.1 for generalized anxiety disorder). List the primary diagnosis first based on which condition is the main focus of treatment. You can also use F32.A for mixed depressive and anxiety disorder if symptoms blend together and cannot be clearly separated.

Should I use PHQ-9 scores to determine severity?

PHQ-9 scores can support your severity determination but should not be the sole factor. Clinical judgment incorporating symptom presentation, functional impairment, and overall assessment takes precedence. PHQ-9 scores of 5-9 suggest mild, 10-14 moderate, 15-19 moderately severe, and 20+ severe. Document the score alongside your clinical rationale for added audit protection.

When should I use F32.9 (unspecified)?

Use F32.9 only when you genuinely cannot determine severity, such as during an initial intake when you need more sessions to assess, or when documentation from a referring provider is incomplete. This code should be temporary and updated once you have enough information for a specific code. Excessive use of F32.9 suggests inadequate assessment and may trigger audits.

Can depression be coded if caused by a medical condition?

Depression due to another medical condition uses a different code: F06.31 (with depressive features) or F06.32 (with major depressive-like episode). F32 codes are specifically for primary major depressive disorder not caused by a medical condition. If hypothyroidism, cancer, or another medical issue is causing depressive symptoms, the F06 codes are more appropriate. Document the underlying medical condition.

Key Takeaways

F32 codes are only for single episodes - use F33 if any prior depressive episodes exist
Severity (mild, moderate, severe) depends on symptom count AND functional impairment
Document episode history, specific symptoms, and rationale for severity selection
Reassess and update codes regularly as treatment progresses
Avoid F32.9 (unspecified) except when temporarily needed during initial assessment
Use standardized measures like PHQ-9 to support clinical judgment

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